Africa: Despite drug-resistant infections, lives can be saved

New York – World leaders commit to action at the UN General Assembly

At the United Nations General Assembly in New York, all countries adopted a major new political declaration to radically increase efforts to combat antimicrobial resistance (AMR), a major threat to modern medicine.

AMR threatens to undo a century of medical progress and could take us back to the pre-antibiotic era, where infections that are treatable today could become much more difficult to treat and potentially fatal tomorrow.

AMR is largely caused by the misuse and overuse of antimicrobial drugs – such as antibiotics – which makes microbes resistant to them and makes diseases more dangerous and deadly.

It is a problem with overall health implications. Healthcare facilities are often where the most persistent treatment-resistant infections arise and spread. AMR makes all types of routine medical procedures riskier; In low- and middle-income countries (LMICs), about 11% of people who undergo surgery become infected.

The burden of treatment-resistant infections is greatest in LMICs, where antibiotic resistance is exacerbated by lack of access to clean water, overwhelmed health systems, limited budgets, poor access to diagnosis and appropriate treatment, and poor regulatory enforcement. Neonatal sepsis spreading in hospitals is a particularly dramatic example of how difficult the situation is in LMICs.

The crisis in equitable access to new and existing antimicrobial medicines is also felt most acutely in LMICs, where lack of availability is a much bigger problem than misuse and overuse – the tools are not there to begin with. Lack of access to vaccines increases the risk of drug-resistant infections, and lack of access to diagnostics makes it more difficult to detect drug-resistant infections and prescribe the right treatments.

AMR also exacerbates challenges in some of the world's most difficult conditions. From Gaza to Sudan to Ukraine, AMRs are making treating war injuries more difficult. Even before the current conflict, antibiotic resistance was found to have increased significantly in Gaza, with resistance to certain antibiotics among injured patients increasing by 300% following the 2018-2019 demonstrations.

The drug-resistant infections that arise in conflict zones rarely stay there as people flee, medical evacuations are organized and soldiers are cared for in hospitals alongside civilians, leading to the spread of antimicrobial resistance. Another reason why peace is the best medicine.

AMR is associated with over a million deaths per year, with the death toll expected to rise in the coming decades.

Dealing with AMR is not easy. What we do know is that plans that include health, environment, animal and agri-food systems lead to progress, but so far they have only been implemented in high-income countries. That has to change.

But while the alarm bells about AMR are getting louder, solutions are not being developed quickly enough, particularly in antibiotic research and development. Since mid-2017, only 13 new antibiotics have been approved, of which only two represent a new chemical class and are considered innovative.

The political declaration just adopted in New York contains commitments and objectives in the areas of human health, animal health, agriculture and the environment.

Key commitments include reducing global deaths associated with drug-resistant bacteria by 10% by 2030 and ensuring that at least 70% of antibiotics used globally for human health belong to the WHO safer access group, which has the lowest potential to cause antimicrobial resistance has. Projections show that many of these deaths are preventable, including by ensuring access to life-saving antimicrobial medicines in LMICs.

The greatest opportunity of this meeting is that it will become a springboard to allocate more resources and turn the goals and commitments in the declaration into reality.

Given the enormous costs of inaction, the investment case for AMR is clear. Four-party and OECD estimates show that AMR could result in additional health spending of up to $412 billion per year worldwide over the next decade unless a stronger AMR response is initiated. It would also result in $443 billion in labor force participation and productivity losses. But this study also shows that implementing critical AMR interventions is a “best buy,” with a return of $7 to $13 expected for every $1 invested.